Equalities Monitoring survey 2020/21 Question Title * 1. What is your age? 0 to 9 10 to 15 16 to 20 21 to 35 36 to 50 51 to 65 66 and above Question Title * 2. Do you consider that you have a disability? No Yes Physical mobility Blind/partially sighted Deaf/hard of hearing Speech/language impediment Mental health problems Long-term health conditions e.g. cancer, HIV, MS Other progressive disability Learning disability Dyslexia Autism Brain injury Facial disfigurement Other hidden disability Yes but do not wish to disclose Question Title * 3. Responsibilities for others I am pregnant or currently breastfeeding I have caring responsibilities e.g. for a family member, neighbour of friend not applicable Question Title * 4. Which of the following describes how do you think of yourself? Male Female In another way Question Title * 5. Marital status Civil Partnered Married Single Co-habiting Divorced Separated Widowed Prefer not to say Question Title * 6. Sexual Orientation Bisexual Gay Heterosexual Prefer not to say Other (please specify) Question Title * 7. Faith or belief No religion Christian Buddhist Hindu Jewish Muslim Sikh Jain Parsi/Zoroastrian Baha'i Other (please specify) Question Title * 8. Your ethnic group White British White Irish Traveller of Irish heritage Gypsy/Roma Any Other White Caribbean African Any Other Black Background Indian Pakistani Bangladeshi Chinese Any Other Asian Background White and Black Caribbean White and Black African White and Asian Any Other Mixed Background Any Other Ethnicity Unknown/Undisclosed Question Title * 9. Are there any barriers to you accessing our services? Question Title * 10. Your relationship with us Client Volunteer applicant Affiliate Counsellor applicant Staff applicant Student applicant Trustee applicant Done